March 28, 2017

By Dave DeFusco

Rachel Noble was a caregiver not long after learning how to read.

“From the age of about 5, I cooked the food, I went to the grocery store, I did the laundry,” she said, describing a weekend ritual she performed well into her teens for her grandmother. “No one asked me to do it. I just wanted to do it. I just wanted to help.”

Her Nana, as she called her, had dementia, but Rachel didn’t realize it until years later. “I just thought she was old. She’d forget things, and that’s just how I thought old people were.”

Rachel spent every weekend and most of every summer at her grandmother’s government-subsidized apartment in Atlanta. Her mother, who kept her distance from her own ailing mother, would drop Rachel off and pick her up in front of the building. She surmised later on that her mother must have visited her grandmother occasionally to take her to the doctor’s and to give her medication.

Rachel Noble provided mental health counseling to young Ugandans during an eight-day mission with the Medical Missions Foundation.

“I still don’t know how much she visited,” said Rachel, a graduate of the Clinical Mental Health Counseling Program at the Johns Hopkins School of Education, “because we don’t really talk about it much.”

When her grandmother was lucid, she displayed a selflessness that betrayed her humble lifestyle. Rachel recalled a moment at a fast food restaurant when her grandmother saw another elderly woman shivering in a nearby booth. Without a word, her grandmother draped her sweater over the woman’s shoulders and sat down. When they had finished eating and got up to leave, Rachel reminded her not to forget her sweater.

“I said, ‘Nana, don’t you need to go get your sweater?’, and she said, ‘She’s a little old lady.’ And I said, ‘Nana, you’re a little old lady.’ She said, ‘No, no, she needs it more than I do.’”

When Rachel was 14, her grandmother, prone to pacing in her apartment, broke her hip and had to be placed in a nursing home. It was then that she learned from her mother that her grandmother had dementia. Rachel kept up the visits, her devotion never wavering, but her grandmother declined rapidly. She languished in a persistent vegetative state for four years until her death.

“That broke my heart. It really killed me,” said Rachel, who went on to study medical ethics as an undergraduate at George Mason University as a result of her experience. “Taking care of her was the best part of my day. Just spending time with her was the highlight of my childhood, because she was my favorite person.”

At George Mason, she conducted a literature review of feeding tube use in terminally ill patients. She also created the Medical Assistance Fund, which provides financial assistance to patients who have medical or mental health concerns that would jeopardize their education if not treated, and was director of Meals for Students in Crisis, another charitable fund she created to provide meals for hungry and homeless college students. She was inducted into several honor societies and graduated summa cum laude.

As a mental health counselor, she specializes in people who are struggling with chronic pain and chronic medical concerns, such as depression and anxiety, bipolar disorder and schizophrenia. From 2013 to 2014, she received specialized training in chronic pain at Johns Hopkins Hospital, where she conducted one-on-one and group counseling sessions with patients in the Pain Treatment Program within the Department of Psychiatry and Behavioral Sciences. She’s now an advisor to the School of Education’s mental health counseling program.

“When someone is stricken with a medical issue, it chips away at their identity, changes who they are,” she said. “It’s for a lot of people the most stressful thing they’ll experience in their lives, and there’s just not a lot of attention paid to that population.”

From 2013 to 2016, she had her own private practice in Bethesda and Washington, D.C., specializing in individuals struggling with complex medical conditions, women’s health concerns and chronic pain. Last October, she joined Advantia Health to establish a new practice of providing mental health care and physical health care in the same office in order to not only de-stigmatize mental health care, but improve outcomes using a team approach.

“People suffering from chronic pain end up isolated from their families and friends because it’s often accompanied by depression and anxiety.”

She recently returned from an eight-day mission to Uganda with the Medical Missions Foundation to provide mental health counseling to approximately 80 females from ages 12 to 16. She was among many health care providers concentrating their efforts in the small northern town of Gulu, where mental health care is uncommon but the need is enormous.

“Trauma is everywhere—abuse, rape, abandonment and death,” she said. “Suicide is rampant.”

She worked with girls who had schizophrenia and major depression, however most of them were sad and frustrated by living in a male-dominated culture. She focused on building self-esteem and dealing with grief and loss. The girls didn’t want to drop out of school, get pregnant and start families before they were 18, she said. They wanted to finish school, work and then have families.

“These girls don’t usually have conversations like this, but they were longing for them,” she said. “We encouraged the girls in group sessions to continue talking with each other after we left, to help each other stay strong and keep trying to have full lives while staying safe.”

Rachel said her experience in Uganda has her wanting to do more international relief work. It’s that same desire she felt when she was a youngster thrust into the improbable role of supporting her grandmother, only now the needs are shockingly desperate.

“People who had gone through these massive traumas could tell you about them as if they were telling you what they had for dinner,” she said. “But when you got to the meat of what they were upset about, it was that they were lonely. That’s when they would cry. You know, we all have our stuff. It’s situational due to our environment, but at the end of the day nobody wants to be lonely.”

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